A man smokes next to a "No Smoking" sign in Shanghai. China is the largest consumer of tobacco. Photo: Reuters

Menthol cigarettes are harder to quit than regular cigarettes, according to a new review of scientific data.

The US Food and Drug Administration (FDA) said on Tuesday that although the mint-flavoured cigarettes do not appear linked to a higher risk of disease, they likely pose “a public health risk above that seen with non-menthol cigarettes”. The US agency said it was considering regulations that could affect sales.

The news may be of particular significance in mainland China and Hong Kong, where a high proportion of people smoke.

China is the largest consumer of tobacco in the world, according to the World Health Organisation's Global Adult Tobacco Survey. An estimated 28.1 per cent of adults in China (52.9 per cent of men and 2.4 per cent of women) were smokers in 2010, and of those, 85.6 per cent lighted up daily.

Menthol smokers appear to be more nicotine dependent than non-menthol smokers

FDA Review

A US study in 2004 found that menthol cigarettes had a 26 per cent market share in Hong Kong, with other surveys indicating that smoking menthol cigarettes is more common among women than men.

Japanese and US researchers reported in 2010 that low tar menthol cigarettes attracted a higher proportion of young adult women in markets where there were increasing numbers of young adult female smokers, including Japan, Hong Kong and Malaysia.

They discovered that menthol cigarettes were appealing to female smokers who wanted low tar cigarettes with less of a tobacco taste, and reduction in odours affecting their hair and clothing. Brands were targeted to women using "feminine" attributes including slim, light and mild.

Smoking in Hong Kong has declined in the past two decades, according to the Census and Statistics Department, hitting a low in 2010 with daily smokers accounting for 11.1 per cent of the population.

However, among daily smokers surveyed in 2008, one year after Hong Kong implemented a ban on smoking in public spaces, 55.5 per cent said they had never tried nor wanted to quit.

Rates of hard-core smokers, defined as daily smokers over 26 who smoked at least 11 cigarettes per day and said they did not want to quit smoking, actually increased by 6 per cent from 2005 to 2008, suggesting a “hardening” of the smoking population in Hong Kong in response to the legislation.

In the US, the FDA stopped short of recommending proposals to restrict or a ban menthol cigarettes and said it was “seeking additional information to help the agency make informed decisions about menthol in cigarettes”.

The European parliament has already approved a ban on menthol and other strongly flavoured cigarettes as part of a series of measures aimed at curbing smoking in the European Union.

According to the FDA's own independent review of the available scientific literature, newer smokers “substantially” prefer menthols.

Menthol smokers are more likely to smoke their first cigarette within five minutes of waking, suggesting the mint flavour is linked to “increased dependence”, it said.

Menthol smokers, particularly African Americans, had a harder time quitting than people who smoked regular cigarettes.

“This is consistent with the observation that menthol smokers appear to be more nicotine dependent than non-menthol smokers which can be an important factor in smoking cessation success,” said the FDA review.